Direct stenting versus stenting after predilatation in STEMI patients with high thrombus burden: a subanalysis from the randomized COMPARE CRUSH trial

Abstract Background/Introduction Direct stenting has been proposed to reduce vessel wall damage and distal embolization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, studies comparing direct after predilatation have shown mixed results so far. Patients presenting high thrombus burden the culprit lesion represent a subgroup of STEMI that may particularly benefit from stenting, as is associated suboptimal reperfusion poor clinical outcomes. Purpose We sought determine efficacy compared burden. Methods The randomized COMPARE CRUSH trial assessed pre-hospital administration crushed versus integral prasugrel tablets planned for PCI. Thrombolysis In Myocardial Infarction (TIMI) flow, corrected TIMI frame count (cTFC) blush grade at end PCI, well occurrence complete (≥70%) resolution 1 hour post-PCI (defined ≥3). Results A total 417 were included current analysis which 336 (81%) presented on initial angiography 144 (43%) being treated stenting. exhibited significantly lower cTFC (16 [12–24] vs. 20 [13–29], p=0.02). Moreover, more frequently (72% 59%, OR 1.82 [95% CI, 1.11–2.99], contrast, we found no differences 3 flow (DS 92% 92%, 1.02 [0.47–2.22], p=0.97) or 63% 54%, 1.45 0.83–2.52], p=0.19) between groups. Conclusion showed improved markers early predilatation, indicating strategy present Randomized trials are warranted further investigate whether potential benefits outweigh hazards over long-term. Funding Acknowledgement Type funding sources: Other. Main source(s): Daiichi-Sankyo Shanghai MicroPort Medical